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HomeMy WebLinkAbout0072 DUNASKIN ROAD "max.,ff{'. �'� .^f- ,,, .• 4 n.r,;. +} n r � ;'. o � P .,.. , F .. .., �_ � �:, lk,• .Y>�... ^'�� �la<. "B �5. �:. Y,. t4. +,. .„.>..h-. .... .-. ;.a -, ,,. ...':: .. bt,-- ... .._.: r,.a..r. �..t.a .., ;i:.., -„ „v .,4, ,t. .:t'' ,�,*` ;a '�.t"• ,#'a: rat sn" Kt , w A, •, ..,�: _ .€ <'.• g u?., ,, y x. ,.. :.„ v: a 5e, .5s sY A, c� �-w. , , ..,'. b5 a.. .sct• � •s:. '� t b,F, ^ �}> a� '� t �y�''�k�F,,ppia 't� e,'i'�°�•{`..w �a Y.. a " �� u �9' i .'�^3�'k> 3 FE-- ,]` r o a w e t y , i U •k _ 1 L 4 } m t r _ G 9 t A : u a e I V .. 1 H 4, _ a , � n Alge Town of Barnstable ` *Permit# Expires,6 months from issue date Regulatory Services Fee PERMOT• srixxsrasie, Richard V.Scali,Director C 28 2015 TOWN Building Division OF BARNSTABZ6 Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY � rA V 0� Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work$ LW,.6G U Minimum fee of$ 5.00 for work under$6000.00 � .r Owner's Name&Address V it..\"C' Q) Contractor's Name _ v - Telephone Number =4k`S -J�Co Home Improvement Contractor License#(if applicable) \:3 Q Email: Construction Supervisor's License#(if applicable) 3lls�a Z`( 4.Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner { c I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit.- Permit Request(check box) �§_Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 16 vz�N c:i� 04,aij h ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the o e I provement Contractors License&Construction Supervisors License is + required. l � SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESSA Revised 040215 DEAN F. STANLEY BUILDING CONTRACTOR,INC. ' Fax and Phone 508428-3466 dstan359@yahoo.com Mass License#035037 H.I.C.License#032149 r September 13,2015 Susan Wood 72 Danaskin Road Centerville,MA I. Windows A. Replace all windows with Anderson white viny1400 series for all double hung windows with grills between glass and white pre-finished interior. same dimensions except lining room and dining room B. All windows remain the flush with face elevation of house. Remove and C. Reframe living room window replace heat under window. D. Replace with boxed 12"Quad double hung window- D. E. Dining room window replaced with 3 double hung windows. F. All windows cased with 21/2'primed colonial casing. $18,65000 H. Doors A. Replace kitchen and garage door"Therma-Tru nine light fiberglass door with new key lock and dead bolt. S Replace flout door with six fight fiberglass door by Therma Tru with new key lock' and dead bolt C. Supply and install new exterior fire door at.dining room entrance with new key lock and dead bolt. $3,680.00 III. Roof A. Remove all asphalt shingles B. Re-nail boarding as`needed. C. Install new 8'aluminum4ri edge. D. Replace 3" and 2"vent flangesr E. Build chimney diverter elu bnd'rhimney.' -, F. Install ice and water shreld at aII eaves areas,valleys and chimney. G. Install underlay paper H. Re-shingle with 30 year Arcbitectfiral style shingle by Certainteed. $12,640A x n � 4 9 IV. Exterior Trim A. Trim cover-face,rakes,corners,returns,beams,door casings and water table over j, brick. B. Removal of existing gutters and downspouts. C. Supply and install hidden vent vinyl soffit on all overhangs after drilling wood to allow for airflow to attic. D. .032 white aluminum gutter with downspouts in place of existing: $8,960.00 V. Exterior steps(rear) A. Remove kitchen and rear garage steps. B. Replace steps with new pressure treated frame with Azek decking to match same dimensions: $1,860.00 ` i V1. Siding A. Remove all:exterior siding except brick. B. Install new window and door flashings. C. Paper all walls with I ypar underlay paper by Dupont. D. Re-shingle all elevations with pre-dipped bleaching oil shingl$15,600.00 k Total Estimate: $61,390.00 f do Signature: Signature: asaa u O � a n;gulls noy;ln+pggn;o - i ,C.►giaaa P R ,_Z£9Z0 HW'3�lIA2i31N3 d 1 HVrl 1 db'D 65£ ::= .',.: V34 A3�Nb'1S N J.3�Nb1S d NH34 uo;sog _ = uoi endx3 9IIZ0�'b1t en ini u 910118ZIL; I P. .P OLIS al!nS-uzuld Maud Oi :add 6y�Z£L3':' :uol;el;sl6a 1 uol;eln2ag ssaulsng pug s.ue33d aawnsuoD;o aag;O i -8013"INOD 1N3W3AOUdW1 3WO a a aao a a g uo� ga�dx yl 3 y wnsuo o aai O :o;uan;aa puno;3I � P •� uoyE►n2ag ssamsng�g sale,{3Y as D 3 3J n uo� ga 92"ao asuaa►D meooLraeioo �a !n� w ao i g 3 �, 2 va ,C uo asn np• ,p 3 P.i �r�ovcc /� ` Massachusetts Department of Public Safety j; Board of Building Regulations and Standards i License: CS-035037 'Construction Supervisor DEAN F STANLEY 359 CAPTAIN LIJAH ROAD � CENTERVILLE MA 02632 - (�z;:K Expiration: Commissioner 01/19/2018 ' AC40 CERTIFICATE OF LIABILITY INSURANCE' °ATE(MWD°"Y„Y) 16. � 1 11/06/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).- PRODUCER CONTACT NAME: Kathleen Geddis NORTHWOOD ESHBAUGH INSURANCE AGENCY, INC. PHONEElk 508 771-1632 FN.No: ADDRESS: kgeddis.north24@insuremail.net 540 MAIN ST. INSURER s AFFORDING COVERAGE NAIC r HYANNIS MA 02601 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B DEAN F STANLEY BUILDING CONTRACTOR INC. INSURERC: INSURER D- 359 CAPT LIJAHS ROAD INSURER E CENTERVILLE MA 02632 INSURERF: COVERAGES CERTIFICATE NUMBER: 10753 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP L R TYPE OF INSURANCE POLICY NUMBER MMID D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMA E O REN EI CLAIMS MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any oneperson) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ • Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PRO HIRED AUTOS PERTY DAMAGE $ AUTOS Per aceident q I $ UMBRELLA UAB HOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I STATUTE ERR AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? WA WA WA 7PJUB2E49857515 10/08/2015 10/08/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 230 Main Street AUTHORIZED REPRESENTATIVE ov Hyannis MA 02601 �u Daniel M.Cr y,CPCU,Vice President—Residual Market—' WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Ile Commormealth ref Miisse diusettr Departm art crf l industrial Accr'derrts Office o,f invffligad ons i600 Washington Street z y... Boston,MA 02111 ' - nP mvmaxsgov1dia '"Tnrkers' CompensatiGn Insurance Affidavit-Builder-JContractnrs/ElectricianslPhambers Applicant lnformafiQn Please Print . 'bI Name{llrmruessitzkg Address: h. A-\IV VA City/Stater: U A APhone Are you an employer?Check the appropriate box: Type of project{required}: 4. I am a general contractor and I I. I am a employer with �J .. ❑ employees(full and/or part-time),* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. . 7..NRemodeling ship and have no employees. These sub-coatrac#ors have g- ❑Demolition working for rue in any capacity. employees and have workers' [ldo works s'comp.insurance comp.fimurancP 1 9. ❑Building addition required.] 5. ❑ We.are a corporation and its 10.❑Electrical repairs:or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or•ad&tions myself [No workers'comp. right of exemption per MGL 17.❑Roofrepairs insurance required,]s. C.152,§1(4X and we have no employees-[No workers' 13.0 Other camp.insurance required-] •Any app@icsrrt tiiat checks log K—also fill out the section below shmming flidrwwRere compo satinuponU iafoungd n_ #Hameoaraers wbo submit this affidz%1t indicating they are doing all WcA aa4&m him outside contractors amst submit anew amdaeit indicating suclL rCaatractors cunt check this bar must attached an additianal sheet don-stg the name of the sub-con trzctm and state whether or not those en iSnbave ewlayees.Ifthesub-contnactors hive empioyees,tk7=srpmuide-their workess' omp.pormyaumber. I arrr arr errrpIo¢�er fJeat is pronzdrrtg workers'coagr¢rrsatiart i�srirarrce f or avr}*¢nrptoy�ees Setoav is fhepoli y and jab site inf ormatiom Insurance Company Name:fi_A V,A e 1� Policy 41 or Self--ins.Lic.k `( U �5 F-kpirat on Date: d ' r(I Job Site Address: City/Statel.tg: J'vy\\ MAI Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secum coverage as required.under Section 25A of c. 152 can lead to the imposition of criminal penalties of a foe up to$1,50D O0 and/or one-year imprisonment,as well as civil peualties.in the fora of a STOP WORK ORDER and a foe of up to M0.00 a day against the violator. Be adiised that a copy of this statement maybe forwarded to the Office of Investigations of the DIAL for insurance coverage verification. I d'o hereby d t ofpegaty that the information pro i&d abm a is tY�re and correct Sitmature. Date- / ` -92i-. Phone Official use only. Do not write in th&area,to be winpleteJd by city ortoorn o;J4dat City or Towu: Permitffikense;g Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.{itylrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions , Massachusetts Geheaal Laws chapter 152 regmres aII eurploye2s to provide wormers'compensation for then employees. Pursuantto this stale,an.nrrplayee is defined as."-.every person in the service of another under any contrast ofhie, express or implied,oral or wrrttE� An Moyer is defined as"an individual,partnership,association,corporation or other legal eafiy,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trust=of an individual,partams,14,association or other legal entity,employing employees. However the owner of a dwelling horse having not more than three apartments and who resides therein,or the occupant of the - dwdji g house of another who employs persons to do maintenance,consfru on or repair Work on such dwelling house or on the grounds or building appurbena thereto shall not because of such.employment be deemed to be an employer." MGL chapter 152,§25C(6)also stains that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings nz the commonePealth for any applicantwho has not produced acceptable evidence of cdmpliance with the insurance.coverage required_" Additionally,MC'rL chapter 152, §25C(7)states`2Ieithes the Commaawealth nor nay of its political subdivisions shall enter haftl any contract for the performance ofpublic work until.acceptable evidence of compliance with the in�ce.. r enfs of this chapter have been presented to the contracting ani3iozit egznremy." Applicarrfs Please fill oil the workers'compensation affidavit completely,by checking tie boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), addresses)and phone number(s)along with their certificates)of insurance. Lmmited Liability Companies(LLC)or Limited Liabi-dty Parbaerships(LLP)withno employees other than tze members or partners,are not nqui3 d to carry workers' compensation msm-ance. Tic an LLC or LLP does have employees,apolicy is reguirerl. Be advised that this affidaYrtmaybe submitted to the Deparment of Industrial Accidents for conf=- ation of i c s ce coverage. Also be sure to sign and date the affidavit Thee affidavit should be retzzmed to the city or town that the application for the permit or license is being requested,not the Department of hadLi stri al Accicients. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-incrtrance license number on the appropriate line. City or Town Officials . t - Please be sun e that the affidavit is complete and primed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of lavestigations has to contact you regarding the applicant Please be sure to fill in the per it license number which will be used as a reference number. In addition,an applicant that must submit multiple permh ficense applications in any given year,need only submit one affidavit indicating current p olicy i af6=ation Cif necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)-"A copy of the•affidavit that has been officially stamped or maiked by tine city or.town may be provided to the applicant as proof that a valid affidavit is on file for Rtare,permits or licenses. A new affidavit must be,filled out each year.Where a home owner or citizen.is obtaining a license or permit not related tQ any business or commercial ventire (Le,. a dog license or permit to bum leaves eta.)said person is NOT regired to complete this affidavit The Office of Investigations would Oct to thank you is advance for your cooperation and should you have any questions, please do not hesitate to give us a call- The Dep_artment's address,telephone and fax number Ike Ca=2MWi-�ata of Massachuaatts Departnant of laid zal Accide nt% Bastes MA 02111 Tf,-L 4 617 727-4900 Qxt 4-06 or I-V7-MASSAFF, Fax 9 617-727-7749 Revised4-24-07 m gQgfdia h 9� 16.19. ,�� Town of Barnstable ArFp�� '.Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner . .200 Main Street, Hyannis,MA 02601 - www.town.barnstable.ma.us Office: 508-8624038 Fax: 5.08-790-6230 Property Owner Must - Complete and Sign This Section n A If Using.A Builder as Owner of the subject property hereby authorize �(,�✓� Lail v' to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date e. Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms0TRESS.doc Revised 040215 Town of Barnstable Regulatory Services " V�E rgry� Richard V. Scali,Director Building Division senNST e Tom Perry;Building Commissioner 1639. ��� 200 Main Street, Hyannis,MA 02601 ED � www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures.'A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe Revised 040215 w • . . L''J 3�Jo�ly C® onwealth of Massachusetts , (� - Sheet Metal Permit Map �2 rarcel ®PRESS PERMIT- Date: Permit# " MAR - 32014 ' Estimated Job Cost: $ 5,11 Permit Fee:,$ _s Plans Submitted: YES .NO OW GF: fI 6&wed- YES NO a Business License# Applicant License# Business Information: Property Owner/.Job Location Information: Name: saodi&h � k t_ 'Name Street: ft .%x 91D :Street lax '(wu)�C City/Town: ,VGA _UC_jg� -D OO Citq/Town: e-2I1)nU �e M( Odle 2- " Telephone: Telephone:. ('�0)an4 cfcm Photo I.D. required/Copy of Photo I:D. attached: YES No- 4 A Staff I®itiaf J-1/M-1-unrestricted license J-2%M-2-restricted to dwellings'3-stories or less and commercial up toL 10000 sq,,ft.i 2-st6ries or less 12esidentlal:'1-2 family Multi-family .L Condo/ Townhouses. Other Commercial: Office Retail -Industrial Educational, Fire Dept.Approval L Institutional Other r , _ s Square Footage: under 10,000 sq,.ft. over,10,000 sq.,ft. Number 6f Stories: Sheet metal work to be completed: New Work: Renovation: µ HVAC Metal Watershed Roofing Kitchen Exhaust System t Metal Chimney/Vents Air Balancing s - g } 'Provide detailed description of work to be done: ' . 1� i �1\Gl�c�(10�CYO S �n 1A55- - k:9 pad t . o INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements,of M.G.L.Ch.112 Yes L1 o❑ If you have checked YX&indicate the e.of coverage by checking;the appropriate,box below. , A liability insurance policy Other type of indemnity ❑ Bond ❑ i OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the i Massachusetts General Laws,and that my signature on this permit application waives this requirement 1 1 f Check One Only R owner [] ` Agent; Signature of Owner or Owner's Agent 1 i By checking this bozo,I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General laws. Duct inspection required prior to Insulation installation:YES NO Date Comments 4 jE jagii Ins ectH II ' Date Comments TiPe.of License: f � 3y Master Title I ❑Master-Restricted pJoumeyperson gnature of Licensee Dermit# ! ❑Joumeyperson-Restricted { License Number.Zee I g p Check at' arn gag, aaovld®I l nspector Signature of Permit Approval ii 2e "60WZWWaiwealt/a a ✓l vac/zcwetGi 9�5 Nlass.,Chusetts - Department of Pubic Safety Office of Consumer Affairs&Business Regulation �0 _: Berra of Building Regulations and Standards u •�T1 ;;HOME IMPROVEMENT CONTRACTOR Re rstration: Construction Superi isnr I & _ Family ° J 9 120859 Type: l , I CSFA-058557 y Expiration 3l12/2014 Private Corporatior a„ SANbWICH CHIMNEY SWEEP IN.C; KEITH A CLIFF = r PO BOX 90 KEITH CLIFF SANDWICH MA'02Sti3 7, 28 EMERALD WAY. FORESTDALE,MA 02644 ter— c-� x F,i ratiotl Undersecretary Jam.(.,.. � • Commiss or}er 02/27/2015 _.COMMONWEALTH OF MASSACHUSETTS':= N . . . ti r a SHEET METAL WORKERS N ►— r U) AS A. MASTER-UNRESTRICTED = A T Q ISSUES THE ABOVE LICENSE To- !---W— "tW� N zW = KEITH A' CLIFF W -�.. ctsRALD WA.Y \ ; r, r F0RESTDALE MA 02644: 153.0 11088 02/28/15 33009rt=6.. Mi and M. Y License or registration valid for individul use only Restricted -One-and two-family dwellings or any ' before the expiration date. If found return to, accessory building thereto, irrespective of size. Office of Consumer Affairs and Business Regulation 10,Park Plaza-Suite 5170 Boston,MA 02116 (/ Failure to possess a current edition of the Massachusetts - Not val i thout signature. State Building Code is cause for revocation of this license. • B For DPS Licensing information visit: www.Mass.Gov/DPS CONTROL# H575047.' -111oPora onmonon'gw000 u."�.c^J _ ---kn" - _nom a �tdae n IMPORTANT C a d " ;; a<D a o d=d a`d a m= If this license is lost or destroyed, notify your Board at the: 3...o......ms>>vv�aaadom C' m n$.; f - - a n F 3 v a . D Division of Professional Licensure, 1000 Washington St., n Suite 710,Boston,MA 02118-6100. & _s s a' - 3 5 Q- If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next - mm�. awF3 f.a^:na swQ Q _ - ,o d:m = Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws. 'mom= -���- maw-m 1 NN gd"- a mmd.Nm d�a 'g a; „. >. o r=_; rn - as amended. It is a personal privilege,and must not be loaned 3 u a� m=.6 or assigned to any other person. Keep this license on your f1 N person or posted as required by law. JLr. L']. [UI H.04 111J�11KHIVl:t dli. ��j . CERTIFICATE OF LIABILITY INSURANCE ➢NM(MMIGDNYM, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ios)must be ondorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,Certain Policies may require an endarsement A statement on this certificate dms not Confer rights to the certificate holder in lieu of such endorsement(s). 1. �RDDuceR MN w Laura J Murphy HART INSURANCE AGENCY,INC. �riorr� =76 >Ax 243 MAIN STREET 508( )76$ 32 ac Pdo (506)759-7366 PO 6OX 700 e-Ma165 ImurPhy@hartinsul'anceagency,com BUZZARDS BAY,MA 025320700 INSURERS AFFORDING eoVa RAGe NAIc ig INSURERA: MAX SPECIALTY INSURANCE 20079 NsuREo S(ndwich Chimney Sweep INSURe:R e: ATLANTIC CHARTER INSURANCE COMPANY 44326 PO Box 90 INsurtER e Sandwich,MA 02963 INSURER D: • INSURER E wsuArR F• OVERAGES CERTIFICATE NUMBER_ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO Tmg INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN:IS SUBJECT TO ALL'THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR TYPE OF INSURArtGE �AD13L WUR POLICY EPF P®LfGY Exp POLICY NUMBER IMMODMIW t! LIMITS A GENERALLIABILRY MAX013100006253 10109/201Z 1010912.013. EACH OCCURRENCE 5 1 A00,000 GCIMMTROIALGaIERALLMILITY � 10109120�3 10109/2014 c= xurrunrb z 100,000 CLAIMS-MADE ®OCCUR " MEDEXP(Any ono om2n S 5,000 PERSONAL&A0V INJURY S 1,000,000 GENERALAGGPr.CATB S 2,000,000 GEN'LAGGREGA7r LIMIT APPLIES PER: PROd=5-OOh1PlCPAGG 3 1,000,000 POLICY PR COG b AUTOMOBILE LIASIUTY - \. ,. pM q yl LE LIMIT ANYAtjTp BODILY INJVRY(Pprp@rzon) S ALL OWNED SCHEDULED - AUTOS AUTOS ._ .50DILY INJURY(Per=440O 3 HIRyDAUTOS NO SWNED ,� WTI, UMBR,E16ALIAB OCCUR EACHOCCURRENCF $ EXCM I= HOLIVMS-MADE AGGREGATE ❑ED1. 141ri ENTION$ ' S 3 WORKERS COMPENSATION WCV01032500 08/28124/3 08I2612074 wosrATu. pTH_ AND EMPLOYERS,uQUiLjTY Y r N ANY CER/m MB R/lMUUPF;D? UTIVE 6,L.EACH ACCIDENT $ 500,000 OFFlCER/MF1vsBER�.(rLUDE07 � N 1 A (Manderoryr In NH) y, If yea.desc(ee Under i E.6,DISEASE-EA Eh9PLOYEE $ 500,000 D8$(`iAvPTIONOF OPERATIONS below R.L.DISEASE-POLICY LIMIT S 500,000 _S'CRIPT(ON OF OPERATIONS I LOCATIONS I WImMES(Attach ACORD I M,Addlit."I Romance Schodula,If m9m wpac®is mqulrea) jerations as performed by Terms&Conditions in the policy. ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESORIsE4 PQLlclES BE CANCELLED BEFORE Town of Earnst&ble THE EXPIRATION DATE THEREOF, NOTICE WILL Be DELIVERED IN 367 Main Street ACCORDANCE WFTH THE POLICY PROVISIONS., Hyannis,Ma,026,01• ` • - - AUTNOR12M REPRI;SENTATIVE Q 1988-2010 AGORD CORPORATION. All dghU reserved. 3ORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Town of Barnstable r Regulatory Services BARS Thomas F.Geiier,Director s63c�. �� � ° Building Division Tom Ferry,Building Commissioner 200 Main Street,Hyannis,IKA 02601 ",w.tow n.barastable.ma.os Office: 508-862-4038 Fax; 508-790-6230 Property Owner Must Co'mpletc and Sign This Section . If UsinLy A Builder ��I, ��R- ,as Owner of the s-abject �pro e P 't9 hereby authorize 1 o act on my behalf, in all m2tters relative to work authorized by this building perm-17. No (Address of job) 'Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are perfor-med and accepted. Signature of inner Signature of Applicant JVW Ptint Name '+' Print Naive Date Q:r0RMS:0WNERPEF-W- SS10NP00L.S